Maternity Care: US versus Malaysia

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Undoubtedly, one of the happiest times of family life may also be one of the most stressful if a pregnant woman, in the United States, finds herself without health insurance, or with health insurance that doesn’t cover maternity care. Between, 1993-2007, the average cost of an uncomplicated cesarean section more than doubled; and the cost of an uncomplicated vaginal delivery tripled. “Looking at a sample of 9 states, researchers found that 17% to 41% of childbearing women lacked insurance before coming pregnant,” says Carol Sakala, director of programs at Childbirth Connection, a nonprofit organization that works on behalf of mothers and babies to improve the quality of maternity care in the U.S. “While 13% to 35% of the pregnant women qualified for Medicaid coverage, many either didn’t qualify or didn’t apply, finding private insurance or paying out of pocket,” Sakala says.

Let’s examine the costs, of what is considered essential care, associated with having a baby in the United States today. The average cost of prenatal care is roughly $2,000, which covers about fourteen doctors’ visits.  High risk pregnancies normally incur more tests and monitoring, which significantly increases prenatal expenditures. Add an additional $0-$300 per test, should blood work, or any other test, be deemed necessary by an OBGYN. The cost of an ultrasound or sonogram costs $100 – $1,000, with an average number of 1-3 during a low-risk pregnancy. An amniocentesis test ranges between $1,100 and $2,000, depending on the facility. The average hospital charge for an uncomplicated cesarean section is $15,800; while an uncomplicated vaginal birth runs about $9,600. A hospital stay afterward can easily increase bills to anywhere from $10,000-25,000. The price range varies widely from area to area and will depend greatly on where a mother lives.

“It’s important to be aware that these numbers reflect the amount a hospital will charge for these services, rather than the actual cost,” says Anne Elixhauser, PhD, senior research scientist at the Agency for Healthcare Research and Quality. “The actual amount of what it costs the hospital to perform the service is about 30% of what’s charged.” Add up these costs and it’s no wonder the average family in the United States has only 1.5 children. The U.S. population growth rate has stagnated for years with a large percentage of its growth stemming from immigration.

Now let’s compare the cost of modern maternity care in the US, with a country that is considered to have a more a traditional culture, such as Malaysia, Southeast Asia; a country I’ve lived in for the last 12 years. In Malaysia, it’s common for maternity care, pre- and post-, not to be covered by insurance. However, maternity costs are very affordable for the typical Malaysian family. Actually, it can be downright cheap to have a baby in Malaysia depending where a family decides to deliver. It must be affordable because Malaysia is a developing economy that is categorized as second world by the World Trade Organization, with a middle income level economy. A typical family earns $15,100 annually; compared with a typical family in the US earning $48,000 per annum. The average number of children per family is 2.6; however this seems low to me. I know many families with at least three or more children.

Nowadays, most births take place in a hospital setting; there are no freestanding birthing clinics, and midwives only practice in hospitals. Malaysia has many public, or government sponsored hospitals. If a family decides to give birth at a public hospital most of the costs are covered by the government; and if you are a government employee, it’s even better, as all the maternity costs are free. At this time the Malaysian government employs one million civil servant with about half being women. Therefore the average government employee normally has more children than those employed by the private sector.

However, the costs for a non-government employee, who chooses to give birth in a government sponsored hospital, are very low. An uncomplicated vaginal birth is $160, a cesarean is $300, and twins are $250. If forceps or vacuum are used, or a breech birth is encountered, an additional $200 is added onto the bill. Daily ward charges range from $1 for a shared room, to $25 for a private room.

Due to the fact that most insurance policies don’t include maternity care, costs vary widely in Malaysia with most hospitals offering competitive “maternity care” packages. Then there is what is called specialist, and semi-private, hospitals that specialize in maternity care. The rates at these types of hospitals are mid-range, with pricing falling between that of public and private hospitals. If a women chooses to have a private OBGYN, at a private hospital, this family would certainly fall into a wealthy income level as the fees are much higher and not be affordable for a typical Malaysian family. For example the cost of each prenatal visit may range between, $30-$100. An uncomplicated vaginal birth is, $1,300–1,600, and an uncomplicated cesarean, $4,000; plus a three to five day hospital stay, costs on average $3,000. A hospital that I know offers the following Maternity Care packages, for a normal delivery with three days and two nights stay for $5,000; and for a cesarean $13,000. Again, this is the high end of the spectrum.

In traditional cultures, like Malaysia, it is considered every woman’s natural right to bear children if they are able to, which is why giving birth is affordable.  It is expected that a woman will give birth in her lifetime, and if there is no medical reason not to, it is viewed as unusual if she doesn’t. Pregnant women are largely supported by the community they are part of, both in the work place and by their family at home. Pregnancy and child birth is an auspicious period, and both the mother and her baby are honored and celebrated in a variety of ceremonies. Birth is slowly becoming medicalized in Malaysia, but it is nowhere near to the degree it is in the US. I don’t think it ever will be like it is in the US, as the strong cultural beliefs and traditions that are firmly in place balance out the pace of the modernization of maternity care.

This post was published previously on Hormones Matter in March 2012. 

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